Wisdom from the Past Extracts From This Journal 1895 and 1920 SEVENTY-FIVE YEARS AGO

little work; if we can knock down, as we believe we can, some of his strongholds, the smaller outworks cannot well be held. Jenner, like most earnest and enthusiastic men, did unquestionably maintain the life efficacy of vaccination. Time has gone on and has shown that vaccination is not more potent against an attack of small-pox than small-pox itself. An attack of severe unmitigated smallpox does not invariably render a person immune to a second attack, or even a second attack to a third; but these cases are very rare, and the supporters of vaccination may admit that small-pox is, perhaps, rather


SEVENTY-FIVE YEARS AGO
"We have read a great many strange things, and we have heard a great many wild statements; but we do not ever remember before coming across an intelligent man like Mr. Hutton, more assertive of doing strict justice to a subject, and at the same time displaying more prejudice and preconceived ideas. Vaccination is no good?and worse?because the author has determined that it is of no avail! tie "will not be learned nor understand, but walks on still in darkness" (p. 70). We do not intend to deal with every point raised in this little work; if we can knock down, as we believe we can, some of his strongholds, the smaller outworks cannot well be held.
Jenner, like most earnest and enthusiastic men, did unquestionably maintain the life efficacy of vaccination. Time has gone on and has shown that vaccination is not more potent against an attack of small-pox than small-pox itself. An attack of severe unmitigated smallpox does not invariably render a person immune to a second attack, or even a second attack to a third; but these cases are very rare, and the supporters of vaccination may admit that small-pox is, perhaps, rather more protective than vaccination and revaccination about the twelfth year: but the process is a very dreaded and dreadful one.
Then there is not a lot of proof that vaccination has any connection with syphilis, as some modern pseudoscientists assert. McVail has shown conclusively that deaths from infantile syphilis are as frequent in Scotland during the first six months of life as in England; and yet vaccination is not carried out 'in Scotland until the sixth month and later. Whereas 'if vaccination were modified syphilis, the roll of deaths in England under six months, ought to outnumber those in Scotland but they do not; nay more, ithe averages for both countries continue as nearly as possible alike, through all ages. Then again, we never knew that people who had syphilis, or who had had it, derived any special protection against small-pox in the way that vaccination unquestionably does confer it, which surely ought to be the case were vaccine modified specific germs." "In Table \  in a population of, say, 324,000, or nearly eleven time" the size of Dewsbury. In the same ratio as Dewsbu^ they would have been 1386. Or, again, to take boasted Leicester. We will admit that the place escaped, so far, a severe incidence of small-pox; what is the mortality of vaccinated persons attack^ as compared with the unvaccinated? 1.1 per cent ' the former, 15.8 per cent in the latter, according to rn? j trustworthy figures published in the British Medic Journal. We may safely predict that Leicester will ft? its day of reckoning yet: ?nd such a town not shows a very bad example, but disperses a lar^ number of unvaccinated persons far and wide, afV thus inflicts imost unfair conditions on other comrn^ . ties. After these statistics and their fallacies, we c^.' appraise at its right value the "reasonable hypoth^ of constitutional immunity" (p. 72), as an explanat1 of the freedom of revaceinated cases from small-P0 and laugh at the charge that vaccination is kept up doctors in Harley Street (note p. 111), and the corp?r tion of doctors generally for pecuniary interest. ' gravamen is absurd in the extreme. It would be more profitable for medical men to vaccinate and ,| vaccinate themselves, their families, and friends, a then let small-pox run rampant. c.
Mr. Hutton is greatly to be blamed for the introd tion of the almost blasphemous picture of calf-woi"5 ^ (p. 115), and, being librarian of a large political c'^ he ought to be specially censured for publishing a P? ' without an index. t^erticulitis is assuming a clinical importance in much agQSarrie manner as appendicitis did about thirty years its .though known to the few, it has not yet found ay to most of the ordinary text-books, and it has YEARS AGO p until recently been regarded by the surgeon only from two aspects?as the chief cause of vesico-colic 'fistula, and las a cause of stenosis of the large bowel resembling malignant disease. The name is not all together satisfactory, as diverticula are congenital and acquired, and 'it is the congenital form with Which most people are more familiar, but the acquired form which is affected in the condition under consideration. Dr. W. H. Maxwell Telling, who opened the discussion on this subject at a recent meeting of the Royal Society of Medicine, and whose remarks are taken as the basis of this review, practically restricts the term "diverticulitis" to the "inflammatory changes and secondary pathologic processes generally occurring in or in connection with a certain type of diverticulum. This type is the secondary, acquired, multiple false diverticula of the large bowel, particularly and -nearly always found in the sigmoid flexure." It should, however, be borne in mind that acquired diverticula may occur in any part of the 'alimentary tract. Acquired diverticula are most common after sixty years of age, and it is probable that constipation is an important factor in their production. As Dr. Telling points out, the diverticula are often overlooked because of their smallness, because they mainly enter the fat-laden appendices epiploicae, and are not discoverable without careful dissection." Diagnosis.?The condition which presents the greatest difficulty is the differentiation between carcinoma of the bowel and the peridiverticulitis which exists as a contracting tumour tending towards chronic intestinal obstruction. Even at the time of operation the diagnosis between these conditions may be impossible, but the following points Telling regards as being in favour of peridiverticulitis: (1) The absence of the "shadows of malignancy" from the general condition; (2) tendency to obesity, and maintenance of good nutrition generally; (3) long history of attacks of abdominal pain in the left lower quadrant; (4) history of tumour formation, with subsequent disappearance; (5) absence of blood (visible to naked eye) in stools over a prolonged period; (6) presence of vesical fistula, in which malignancy can be excluded by cystoscopy; (7) negative sigmoidoscopy as regards malignant disease; (8) X-ray demonstration of diverticula; (9) pyrexial attacks; (10) examination of blood showing the presence of neutrophilic leucocytosis, and the absence of ithe specific nuclear changes characteristic of cancer. Sigmoiditis, hyperplastic tuberculosis, actinomycosis, syphilis and pelvic conditions generally may require consideration in forming a diagnosis.
Treatment is by operation unless there is some special contraindication. All diventiculum-bearing gut should be removed, or recurrence may take place. There seems to be a special liability to post-operative peritonitis in some cases. Care should be taken in handling the gut, less rupture of la diverticulum should occur. No case of supposed carcinoma of the lower bowel should in future be regarded as inoperable unless diverticulitis 'has been fully considered." James Swain. (Vol. 37, pp. 57-59, 1920)